Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial

Cost-Effectiveness of In-Bed Cycling and Routine Physiotherapy for Patients Receiving Mechanical Ventilation

Jean-Eric Tarride et al. JAMA Netw Open. .

Abstract

Importance: The cost-effectiveness of adding early in-bed cycling to usual physiotherapy among adults receiving mechanical ventilation in the intensive care unit (ICU) compared with usual physiotherapy alone is unknown.

Objective: To evaluate the cost-effectiveness of in-bed cycling plus usual physiotherapy compared with usual therapy alone in the Critical Care Cycling to Improve Lower Extremity Strength (CYCLE) randomized clinical trial.

Design, setting, and participants: This trial-based economic evaluation with a 90-day time horizon compared early cycling plus usual physiotherapy vs usual physiotherapy alone from a societal perspective. Adult ICU patients (aged ≥18 years) receiving mechanical ventilation were recruited from 16 ICUs in Canada, the US, and Australia. Enrollment occurred from November 1, 2016, to May 30, 2023, with the last follow-up on August 3, 2023.

Interventions: Intervention group participants were offered 30 minutes per day of cycling in addition to usual physiotherapy on weekdays, starting within the first 4 days of mechanical ventilation. Cycling continued until the patient could march on the spot for 2 consecutive days, ICU discharge, or for 28 days, whichever occurred first. Usual care participants were offered individualized physiotherapy according to local practices and patient alertness.

Main outcomes and measures: Differences in costs (in 2024 Canadian dollars [CA$]) and quality-adjusted life-years (QALYs) between the groups were calculated. In the absence of dominance (ie, 1 strategy is associated with higher costs and fewer QALYs), the results were reported in terms of incremental cost per QALY gained.

Results: The CYCLE trial recruited 360 patients (mean [SD] age, 61.5 [15.6] years; 205 male [56.9%]). The estimated per-patient cost associated with providing early in-bed cycling (CA$321) represented 0.5% of the index hospitalization costs (CA$66 554). The per-patient differences in 90-day costs (CA$5841; 95% CI, -CA$7666 to CA$18 797) and QALYs (-0.0009; 95% CI, -0.0185 to 0.0182) between cycling plus usual physiotherapy vs usual physiotherapy alone were not statistically different from 0. The probability of cycling plus usual physiotherapy to be cost-effective was 0.19 at a willingness-to-pay threshold of $50 000 per QALY gained.

Conclusions and relevance: In this trial-based economic evaluation, the differences in costs and QALYs between adding early in-bed cycling to usual physiotherapy and usual physiotherapy alone for adults receiving mechanical ventilation were not significantly different from 0. These results highlight the need for additional cost-effectiveness studies considering the full body of evidence regarding in-bed cycling for critically ill patients.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Dr Tarride reported receiving grants from the Canadian Institutes of Health Research (CIHR) during the conduct of the study. Dr Fox-Robichaud reported receiving grants from CIHR outside the submitted work. Dr Seely reported being founder and chief executive officer of Therapeutic Monitoring Systems outside the submitted work. Dr Berney reported receiving grants from the CIHR during the conduct of the study. Dr Pastva reported receiving grants from a McMaster University subcontract during the conduct of the study. Dr Archambault reported receiving grants from CIHR during the conduct of the study. Ms Heels-Ansdell reported receiving grants from CIHR during the conduct of the study. Dr Cook reported receiving grants from CIHR during the conduct of the study. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Number of Patients Contributing Data to the Cost-Effectiveness Analysis
At each time point, the number of patients alive and the number contributing to the length of stay (LOS), economic, or health-related quality-of-life (EQ-5D-5L) analyses are reported. The Critical Care Cycling to Improve Lower Extremity Strength (CYCLE) trial included a vanguard phase of 46 patients for whom postrandomization 90-day follow-up data were not collected due to lack of funding. ICU indicates intensive care unit.
Figure 2.
Figure 2.. Incremental Costs and Quality-Adjusted Life-Years (QALYs) of Cycling Plus Usual Physiotherapy vs Usual Physiotherapy Alone
This scatter plot of 1000 bootstrap simulations summarizes the costs and QALYs of early intensive care unit cycling plus usual physiotherapy vs usual physiotherapy alone.
Figure 3.
Figure 3.. Cost-Effectiveness Acceptability Curve
QALY indicates quality-adjusted life-year.
See this image and copyright information in PMC

References

    1. Adhikari NK, Fowler RA, Bhagwanjee S, Rubenfeld GD. Critical care and the global burden of critical illness in adults. Lancet. 2010;376(9749):1339-1346. doi: 10.1016/S0140-6736(10)60446-1 - DOI - PMC - PubMed
    1. Kaukonen KM, Bailey M, Suzuki S, Pilcher D, Bellomo R. Mortality related to severe sepsis and septic shock among critically ill patients in Australia and New Zealand, 2000-2012. JAMA. 2014;311(13):1308-1316. doi: 10.1001/jama.2014.2637 - DOI - PubMed
    1. Peñuelas O, Muriel A, Abraira V, et al. Inter-country variability over time in the mortality of mechanically ventilated patients. Intensive Care Med. 2020;46(3):444-453. doi: 10.1007/s00134-019-05867-9 - DOI - PMC - PubMed
    1. Herridge MS, Tansey CM, Matté A, et al. ; Canadian Critical Care Trials Group . Functional disability 5 years after acute respiratory distress syndrome. N Engl J Med. 2011;364(14):1293-1304. doi: 10.1056/NEJMoa1011802 - DOI - PubMed
    1. Ohbe H, Yokokawa Y, Sato T, Kudo D, Kushimoto S. Development and validation of early prediction models for new-onset functional impairment of patients with trauma at hospital discharge. J Trauma Acute Care Surg. 2025;98(1):167-178. doi: 10.1097/TA.0000000000004420 - DOI - PubMed

Publication types